Independent Review Welsh Ambulance Service NHS Trust’s Approach

45 Pages·2010·0.22 MB·English

Independent Review

Welsh Ambulance Service NHS Trust’s
Approach to Engagement

April 2010

For further information please contact:

Helen Bidwell or Ben Hickman
Vision Twentyone
Milton Hall
Deansgate
Manchester
M3 4BQ

Tel: [phone]

Email: [email protected]
[email protected]

Web: www.visiontwentyone.co.uk

Supported by:
National Leadership & Innovation Agency for Healthcare (NLIAH)
Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

Acknowledgements

Vision Twentyone would like to thank Barbara Bowness, Associate Director of
Partnership Development at NLIAH1 for kindly commissioning this work on behalf of
WAST. We would also like to thank the Partners in Healthcare team, particularly
Leanne Hawker and Alison Johnstone, who were refreshingly open, honest and
welcoming throughout the project. Finally, as special thank you to everyone who gave
up their time to be interviewed and attend the workshop, without their input the
project would not have been as successful and enjoyable as it was.

“There's innovation, incredible commitment and lots of hard
work. The stuff they are doing works, and in my view is what
patient engagement should look like.”
Non-Executive Director

1 National Leadership and Innovation Agency for Healthcare

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Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

CONTENTS Page

1.0 Executive Summary 4

2.0 Introduction 7

3.0 Context 8

4.0 Method 10

Part 1 – Engagement Activity

5.0 Planning 14

6.0 Implementation 16

7.0 Record Keeping 27

8.0 Evaluation 29

Part 2 – Engagement Outcomes

9.0 Communicating and Using Outcomes 32

10.0 Prevalence of an ‘Engagement Culture’ 35

11.0 Promoting an Engagement Culture 40

12.0 Conclusion 43

13.0 Summary of Recommendations 44

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Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

1.0 EXECUTIVE SUMMARY

1.1 Context
 In 2007, the Welsh Ambulance Service NHS Trust (WAST) promised that
the involvement of patients and the public would underpin their
development and pledged to increase patient and public involvement at all
levels within the organisation2.

 Historically WAST conducted ‘very little patient and public involvement’3,
however since establishment of the new Partners in Healthcare (PIH) team
a wide reaching programme of engagement has been implemented.

 The latest ‘Partners in Healthcare’ strategy represents a renewed focus
and a desire to further improve engagement activity. This offers an
opportunity to learn from previous work and build on past success.

 It is in this context that the National Leadership and Innovation Agency for
Healthcare (NLIAH) commissioned Vision Twentyone to conduct a review
of WAST’s approach to engagement. This report provides a summary of
that review; highlighting good practice and offering recommendations for
the future.

1.2 Engagement Activity
 PIH’s strategy and project planning clearly identifies the drivers behind
engagement from an organisational perspective, sets out a vision for the
team and identifies the steps required to achieve that vision.

 The context in which WAST comes into contact with patients presents
unique challenges when seeking to capture and learn from patient
experience. PIH has overcome this by developing a network of members
who are engaged in an ongoing two-way dialogue.

 The wide range of activities PIH undertake through the network maximise
opportunities for involvement with the Trust and promote an inclusive
approach to engagement.

 There is a need to review the demographic make-up of the panel and
conduct targeted recruitment as part of ongoing management. This will
ensure that the network becomes increasingly representative of the Welsh
population.

 There are a number of opportunities to build on existing activities and
develop new projects that will further engagement, which include the
following recommendations:
 Expand the Readers Panel to include Welsh Language reviews
 Develop the Panel meetings to focus more on project planning
 Develop an Advisory Panel of service user representatives
 Continue to grow the Patient Stories project
 Implement the planned Mystery Shopper scheme.
 Develop an accessible patient feedback mechanism in partnership
with Complaints and Litigation.

2 Time to Make a Difference - Transforming Ambulance Services in Wales (2007)
3 Clinical Governance Review, Commission for Health Improvement (2004)

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Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

 The team has well developed record keeping systems to support their
engagement activities. The new PIH Directory will enable them to play an
increasingly important role in the coordination of engagement activities
across the Trust.

 The PIH Directory has potential to be used more widely across Wales. It
could play an important role in public service engagement; facilitating
shared learning and coordination, and helping to avoid duplication.

 The PIH team are clearly committed to meaningful evaluation of their work
and reflective learning. As well as regular internal project evaluation and
an appetite for the external review, PIH has developed a ‘Planning and
Evaluation Toolkit’ which is now being used by organisations across Wales.

1.3 Engagement outcomes
 PIH has a range of external communications channels which are used to
raise awareness of the outcomes of engagement and feedback to patients,
the public and partners.

 There are channels in place to ensure that the outcomes of engagement
activity are communicated and acted upon within the Trust. However, the
Trust’s record of acting on the outcomes of engagement is mixed.

 Outcomes of engagement are acted on when:
 There are strong working relationships between PIH and relevant
departments.
 There is board level support for PIH and the project in question.
 Departments/individuals have a good understanding of PIH,
engagement and its value.
 There are good channels of communication between departments.
 PIH has direct control over an outcome.

 There are clear indications that at Board level, the work of PIH is valued
and understood. Moves to incorporate the new ‘Public Health and
Engagement Strategy’ within the Trust’s strategic framework signal an
increased awareness of the centrality PIH needs to take within the Trust.

 Processes to identify when formal consultation is required by current
legislation on service design and delivery need to be developed. The
creation of a ‘Director of Strategic Development’ presents a good
opportunity to strengthen Board level responsibility for this work.

1.4 Current culture of engagement
 It is clear that a culture of engagement does not extend as extensively
within the Trust as it could do. There is a need to increase awareness of
the work PIH do, foster a greater understanding of the role of engagement
and develop a wider appreciation of its value.

 Perceptions of engagement are impacted upon by the operational focus of
the Trust and the fact that engagement is seen as separate from, rather
than integral to, this function.

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Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

 As part of providing a ‘user-centred service’, WAST can further embed a
culture of engagement by influencing people’s perceptions of
engagement, illustrating the impact this has on their role and the work of
WAST, both on a strategic and everyday level.

 Internal communications are integral to current and future promotion of
the culture of engagement within the Trust. However, it is apparent that
communications as a whole are underdeveloped and under-resourced.

 There is scope to address the resourcing issues relating to
communications, develop a comprehensive communications strategy and
continue to develop and improve internal staff communications
mechanisms.

 To further promote a culture of engagement, it is recommended that PIH
develop an internal communications and promotions plan that:
 Identifies key internal stakeholder groups and individuals
 Establishes PIH champions within departments across the
organisation
 Develops a consistent set of messages
 Tailors mechanisms for communicating with each audience
 Identifies a lead member of the PIH team responsible for
communicating with each group or champion.

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Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

2.0 INTRODUCTION

Traditionally, public services have not always been responsive to service users’
needs and expectations. However, in recent years governments and individual
public service agencies across the UK have been working to extend and develop
engagement practice. This ambition offers a means of developing user-centred,
high quality services alongside a process to strengthen democratic governance
and accountability4.

However, a recent report by the former Healthcare Commission5 highlights that
people generally do not feel that they have enough say in the health services that
are provided in their area, or the way they are delivered. In reality, few healthcare
Trusts can demonstrate that people’s views routinely influence their decision
making. Healthcare organisations recognise these problems, and have been
working to engage more people, more effectively and make better use of the
views and experience they hear.

In this context, the Welsh Ambulance Service NHS Trust commissioned a review
of their engagement activities. The review reflects a commitment to the principles
of engagement and an appetite for constant learning and improvement. Based on
the review process, this report provides good practice examples and develops
recommendations for the future.

4 Making Consultation Real – A Toolkit for Health and Social Care (2006)
5 Listening, Learning and Working Together? Healthcare Commission (2009)

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Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

3.0 CONTEXT

Before exploring WAST’s engagement practice in detail, it is important to
understand the context in which the activity is taking place. This section explores
the national, organisational and historical context of WAST’s engagement activity
and introduces the Partners in Healthcare (PIH) team and their vision.

3.1 Engagement in Public Services in Wales
In 2005, ‘Designed for Life’6 set out a vision for health and social care in Wales. It
pledged by 2015 to ‘ensure full public health engagement at both local and
national levels’. Fundamental to its vision is to provide ‘user-centred services’ and
to ‘empower the community to have its voice heard and heeded’. A year later,
‘Making Connections’7 reaffirmed this emphasis on engagement with the need to
‘embed an ethos of putting citizens first’ as ‘central to achieving radical change’.

Beyond this strategic context, there are a number of more practical documents
that provide guidance on what public engagement should look like in Wales. These
include the ‘Signposts I’8 and ‘Signposts II’9 publications, ‘Making Consultation
Real’10 and ‘Shaping Health Services Locally’11. Each of these demonstrates an
ideal to which public services should aspire. They offer pathways for organisations
to become increasingly responsive and accountable and methods for placing
patients and the public at the heart of planning and provision.

Furthermore, the Welsh Assembly Governments’ ‘Healthcare Standards’12 drive
engagement by making the principle fundamental to the assessment of Trusts.
The stated purpose of the standards is to ensure a focus on ‘improving the patient
experience’, ‘placing patients at the centre of the way in which services are
planned and delivered’. As a consequence, a Trust’s ability to ‘seek and take
account of the public’s point of view when planning and delivering service’ is a
direct measure of its capability and success.

3.2 The Welsh Ambulance Service NHS Trust and Engagement
‘Time to Make a Difference’13 published in January 2007 sets out WAST’s
commitment to achieving the ‘Designed for Life’ vision. Acknowledging the role of
engagement in public services, it includes a promise that ‘the involvement of
patients and the public will underpin development’ and an assurance that WAST
will ‘increase patient and public involvement at all levels within the organisation’.

6 ‘Designed for Life: Creating World Class Health and Social Care for Wales in the 21st Century (2005)
7 Making the Connections – Delivering Beyond Boundaries (2006)
8 Sign Posts I – A Practical Guide to Public & Patient Involvement in Wales (2001)
9 Sign Posts II – Putting Public & Patient Involvement into Practice (2003)
10 Making Consultation Real – A Toolkit for Health and Social Care (2006)
11 Shaping Health Services Locally: Guidance for Involving and Consulting on Changes to Health Services
(2004)
12 Healthcare Standards for Wales – Making the Connections Designed for Life (2005), Healthcare
Inspectorate Wales
13 Time to Make a Difference - Transforming Ambulance Services in Wales (2007)

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Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

To deliver this promise, WAST completed a review of their involvement strategy
and implemented a new ‘Patient and Public Involvement Strategy14 between
2007 and 2009. Its scope has been far reaching, covering work with community
health councils, developing links with other providers, building relationships with
the voluntary sector and establishing mechanisms for dialogue with patients and
the public.

To place the impact of this new strategy in context, a 2004 Commission for
Health Improvement report concluded that the Trust had ‘very little actual public
and patient involvement’ and that there was ‘no formal committee structure to
support it’15. Therefore, with no previous comprehensive and governed structure
for involvement and engagement, the Partners in Healthcare (PIH) model has been
developed, implemented and embedded over the last few years by a highly
dedicated, innovative and passionate team.

3.3 The Partners in Healthcare (PIH) Model
The PIH Team works across the Welsh Ambulance Service NHS Trust (WAST) with
core staff working at a local, regional and national level. The team works to
improve public health through the provision of information and an approach to
continuous engagement with the people of Wales.

The term ‘Partners in Healthcare’ defines a partnership approach in developing
services, and improving user experience. The model encourages ongoing
involvement and engagement with partners, to include: patients, service users,
citizens, health and social care professionals, patient groups, and the voluntary
sector.

The PIH ‘message’ is to inform and educate individuals about the Trust and its
different functions. The team also has a remit for health information, education
and promotion (which is delivered through the Health Information Department
within NHS Direct Wales).

The PIH vision is to:
 Enable communities to become involved in the planning, design and
delivery of services.
 Ensure the Trust is fully signed up to implementing the principles of
Partners in Healthcare.
 Improve people’s health and well-being through local partnership working.

3.4 This Report
WAST’s new ‘Partners in Healthcare’ strategy represents a renewed sense of
focus within the organisation and a desire to further improve engagement activity.
This offers an important opportunity to learn from previous work and build on
past success. Therefore, the National Leadership and Innovation Agency for
Healthcare (NLIAH) commissioned a review of WAST’s approach to engagement.
This report provides a summary of that review. It highlights the good practice of
the PIH team, provides insight into some of their innovative solutions for
engagement, and provides a set of practical recommendations that will help to
shape future activity.

14 Welsh Ambulance Trust – Patient and Public Involvement Strategy 2007-2009 (2008)
15 Clinical Governance Review, Commission for Health Improvement (2004)

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Independent Review: Welsh Ambulance Service NHS Trust’s Approach to Engagement

4.0 METHOD

This section provides an overview of the methodology Vision Twentyone used to
conduct the review. The approach was based on openness and transparency,
ensuring everyone involved understood the scope and reasons behind the
process. It incorporated desk research, in-depth interviewing and a forward-
planning workshop.

4.1 Objectives
The aim of the review process was to identify current approaches to engagement
and assess their effectiveness from the perspective of WAST and its partners. The
components that were explored included:

1) Engagement activity:
a) Planning.
b) Implementation.
c) Record keeping.
d) Evaluation.

2) Engagement outcomes:
a) Prevalence of an engagement culture.
c) Communicating outcomes.
d) Using the outcomes.

4.2 Stage One
As summarised by the diagram below, the first stage of the review process
combined an iterative period of desk research, questionnaire development and in-
depth interviewing.

Iterative review process

Framework Questions

Desk Research

Interviews

On inception, Vision Twentyone completed a period of desk research to fully
understand the context of WAST’s engagement activity. This included a review of
national policy and guidance, WAST’s engagement strategies, engagement
materials and project documentation. Following this, a ‘Review Framework’ was
produced against which data was collected and recorded.

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